The question of drug dosages in the Shanghan Lun (Treatise on Cold Damage) has long been a subject of academic controversy. However, following the excavation of numerous artifacts from Han dynasty tombs, we now know that one liang (两) during the Eastern Han period should have been 15.625 grams. Logically, this should have settled the matter once and for all — yet the debate continues to this day. Why?
The current confusion likely stems from a claim made by Zhang Taiyan in the eighth collection of his Medical Discourses, where he stated that “one ancient liang is closest to between two and three qian (钱) today.” From the Ming and Qing dynasties through the early years of the People’s Republic, one qian was equivalent to approximately 3.72 grams. As this claim evolved into modern textbooks, it became simplified to “one ancient liang equals roughly 3 grams today,” and many formula conversions in current textbooks follow this rule.
From a scientific standpoint, this is clearly wrong. Any inference pales before the evidence of excavated artifacts.
So why hasn’t it been corrected?
The answer is simple: starting from the Ming dynasty, physicians and society at large embraced the belief that “ginseng can kill without blame, while rhubarb saves without merit.” This caused many medicines to fall out of normal use according to their pharmacological properties as described in the Bencao (Materia Medica).
Take, for example, Guizhi Tang (Cinnamon Twig Decoction), known as the “ancestor of all formulas.” In the original text of the Shanghan Lun, it is recorded as follows:
Cinnamon twig, peeled (3 liang), White peony root (3 liang), Licorice root, honey-roasted (2 liang), Fresh ginger, sliced (3 liang), Jujube, broken open, 12 pieces.
Take these five ingredients, chew the first three into coarse pieces, boil in seven sheng of water over gentle heat until reduced to three sheng, remove the dregs, and drink one sheng when warm. Shortly after, sip a little over one sheng of hot thin porridge to assist the medicine’s effect. Keep warm for about one shi (a traditional time period); a light, even sweat over the entire body is ideal. Do not allow profuse sweating, or the illness will not be resolved.
If one dose induces sweating and the illness resolves, discontinue the remaining doses. If no sweating occurs, take another dose following the same procedure. If still no sweat, shorten the interval between doses and finish all three within half a day. For severe cases, administer day and night, observe after one full day-night cycle, and if symptoms persist, prepare another dose. If sweating still does not occur, continue until two or three doses have been taken. Avoid raw, cold, sticky, slippery foods, meat, wheat products, the five pungent vegetables, wine, dairy, and foul-smelling substances.
If one liang equals 15.625 grams, a single dose would require 46.875 grams of cinnamon twig — a quantity that most contemporary physicians would find nearly unimaginable. In my clinical experience, cinnamon twig in modern prescriptions typically ranges around 10 grams, rarely exceeding 30 grams.
Of course, cinnamon twig is a minor concern. The real problem arises with Da Qinglong Tang (Major Blue Dragon Decoction), which calls for 6 liang of ephedra per dose. Even accounting for the decoction method — where only one-third of the total is consumed at a time — a single serving would contain 30 grams of ephedra. This is a quantity that physicians since the Yuan dynasty have found almost inconceivable.
What is most intriguing is that people’s attention seems fixated only on those herbs they themselves dare not use. After all, converting “six liang of ephedra” to “six qian of ephedra” is something some physicians can accept. But applying this same logic to many other formulas reveals a different picture entirely.
Consider, for instance, Fangji Huangqi Tang (Stephania and Astragalus Decoction) from the Synopsis of the Golden Chamber:
Stephania root (1 liang), Licorice root (½ liang), Atractylodes macrocephala (7½ qian), Astragalus root (1 liang 1 fen).
Pound into hemp-seed-sized pieces. Take 5 qian per dose with 4 slices of fresh ginger and 1 jujube, boil in 1½ cups of water until reduced to 8/10, remove dregs, and drink warm. Repeat after a while. For wheezing, add ½ liang of ephedra; for stomach disharmony, add 3 fen of peony; for upward-rushing qi, add 3 fen of cinnamon twig; for chronic cold in the lower body, add 3 fen of asarum. After taking, one should feel as if insects are crawling under the skin, and the area below the waist should feel cold. Then sit on a quilt, wrap another around the waist and below, and keep warm until a light sweat appears. Recovery will follow.
Or take Huangqi Jianzhong Tang (Astragalus Center-Fortifying Decoction):
Astragalus root (1½ liang), Cinnamon twig (3 liang), Licorice root, honey-roasted (3 liang), Jujube (12 pieces), Peony root (6 liang), Fresh ginger (3 liang), Maltose (1 sheng).
I genuinely cannot understand why the blatant falsification on Baidu Baike (as of today’s date) goes unchecked.
Needless to say, a comprehensive review of the Shanghan Lun reveals that Zhang Zhongjing used remarkably small quantities of astragalus. To this day, I have not found a single practitioner who prescribes Huangqi Jianzhong Tang according to the original proportions. It seems the prevailing view nowadays is that astragalus can be used in large doses.
The same logic applies to Suanzaoren Tang (Sour Jujube Seed Decoction) and countless other formulas. Why is it that prescriptions composed of these particular herbs can be used at normal or even excessive doses, while formulas containing aconite, ephedra, or cinnamon twig must be subjected to over-interpretation, or even deliberate falsification and distortion of historical truth?
When will Traditional Chinese Medicine embrace the spirit of seeking truth from facts? When will it return to its authentic roots?
Alas!
中文原文 / Chinese Original
伤寒论中药物的剂量问题学界始终有争议，但在汉墓出土诸多文物后，我们发现东汉时期一两应该是15.625克，按道理说早就应该正本清源，但为何至今还在讨论中呢？
造成目前的混乱可能来源于章太炎《医论》第八集在《论汤剂轻重之理》提出的”古一两今在二钱到三钱间者为近”，从明清至新中国初期，一钱相当于现在3.72克。此说法衍化到现代教科书中，就变成了”古代一两相当于现在3克”，课本中许多方剂的计量换算都是按照这个规则进行的。
从科学角度上讲，这显然是错的，任何推断在出土文物面前都是渣渣。
但是，为什么不改呢？
原因很简答，从明朝开始，医家乃至整个社会都信奉”人参杀人无过，大黄救人无功”，这造成了很多药物不能按照本草药性正常使用。
举例来说，被称为”群方之祖”的桂枝汤，在伤寒论原文中是这么记载的：
桂枝去皮(3兩) 白芍(3兩) 甘草炙(2兩) 生薑切(3兩) 大棗擘12枚
右五味，（口父）咀三味，以水七升，微火煮取三升，去滓，適寒溫，服一升。服已須臾，啜熱稀粥一升餘，以助藥力，溫服令一時許，遍身漐漐微似有汗者益佳；不可令如水流漓，病必不除。若一服汗出病差，停後服，不必盡劑；若不汗，更服，依前法；又不汗，後服小促其間，半日許令三服盡。若病重者，一日一夜服，周時觀之，服一劑盡，病證猶在者，更作服；若汗不出，乃服至二、三劑。禁生冷、粘滑、肉麵、五辛、酒酪、臭惡等物。
如果一两是15.625克换算，一付药需要46.875克的桂枝，这是大部分医家极难想象的一个量，目前我在临床上看到的各类方子，桂枝一般在10克左右，极少超过30克，当然了，桂枝是个小问题，但是大青龙汤就是个大问题了，大青龙汤中记载一付药需要麻黄6两，就算按照煎煮法，先服用总剂量的三分之一，一次喝掉30克麻黄，是元代以后医家都很难想象的。
最有意思的是，人们的眼光似乎只停留在这些自己不敢用的药上，毕竟将麻黄六两换成麻黄6钱之后，有一些医家还是能接受的，但是，用这个观点看很多其他方剂就不是这么回事了。
譬如说，金匮要略中记载的防己黄芪汤：
防己一两 甘草半两 白术七钱半 黄芪一两一分
右锉麻豆大，每抄五钱匕，生姜四片，大枣一枚，水盏半，煎八分，去滓温服，良久再服。喘者加麻黄半两；胃中不和者加芍药三分；气上冲者加桂枝三分；下有陈寒者加细辛三分。服后当如虫行皮中，从腰下如冰，后坐被上，又以一被绕腰以下，温令微汗，差。
再比如说，黄芪建中汤：
黄芪一两半 桂枝三两 甘草炙三两 大枣十二枚 芍药六两 生姜三两 胶饴一升
我都不明白，百度百科（截至今日）上明目张胆的造假为什么就没人管管。
不用多说，纵观伤寒论，仲景用黄芪的量是非常小的，我至今没有发现谁家开黄芪建中汤是按照原方比例来的，貌似现在人们的观点都认为黄芪可以大剂量使用。
酸枣仁汤等等等等都是同样的道理，为什么这些药物组成的方子，就可以正常剂量或者大剂量的使用，而含有乌头、麻黄、桂枝的方子就要使用各种手段过度诠释、甚至伪造曲解历史真相呢？
中医何时才能实事求是？何时才能正本清源？
呜呼哀哉
发表回复